Caring for Your Implantable Cardiac Defibrillator (ICD)

Transcription

1 Patient Education Caring for Your Implantable Cardiac Defibrillator (ICD) What you need to know Weekdays between 8 a.m. and 4:30 p.m., call an Electrophysiology (EP) Nurse at Weekends, holidays, or after hours, call the paging operator at and ask for the Electrophysiology (EP) Fellow on call to be paged. The EP Fellow is a doctor who works with your primary electrophysiologist. These doctors specialize in caring for patients with ICDs. This handout provides information that will be helpful to you right after your ICD is put in place and later, as your life returns to normal. Wound Care Call one of the numbers in the left column right away if you have: - Redness - Swelling - Drainage - Fever above 99.5 F (37.5 C) - Chills - Any concerns or questions about your wound Remove your dressing (bandage) within 24 to 48 hours after your surgery. Do not put lotion or powder on your incision until it is completely healed. Avoid touching the area over or around your ICD. Do not poke or twist your ICD. Add some padding to your seat belt strap if it crosses over your ICD implant site. Keep this padding in place until your wound is completely healed. If your wound is closed with a skin glue: - You may shower 48 hours after your surgery. - Do not soak your incision until it is completely healed.

2 Page 2 If your wound is NOT closed with a skin glue: - Your wound will be closed with tape called Steri-Strips. These strips will fall off on their own in about 1 week. - Wait at least 5 days after your surgery before you shower. - Do not soak your incision until it is completely healed. Do not allow anyone to poke or probe your incision with fingers or instruments before checking with us first. If a health care provider feels this needs to be done to provide your care, have them call the EP Fellow before doing this type of exam or procedure. Your wound will be checked 7 to 14 days after your surgery. It is very important that you keep this appointment and all your follow-up appointments. See the last page of this handout for your appointment information. Activity Restrictions Wear a sling for the first 24 hours after surgery. If you have travel plans in the first 2 weeks after your surgery, please check with your doctor for further instructions. For the first 30 days after your surgery: Do not push, pull, strain, twist, or make any sudden jerking movements with your arms or upper body. With the arm that is on the same side as your surgery: - Do not lift more than 10 to 15 pounds. - Do not lift your elbow higher than your shoulder. - Do not raise your arm over your head. - Do not lift anything over your head. - Do not put your arm behind your back. Long-term: Follow your doctor s instructions about driving and sexual activity. Check with your doctor before you do activities that involve swinging your arm (such as swimming, golfing, tennis, or vacuuming) or doing things that can injure your shoulder or wound site (such as shooting a gun, wrestling, or playing football). These restrictions could last 3 months or longer, based on your treatment plan. Continue to avoid touching the area over or around your ICD. Do not poke or twist your ICD.

3 Page 3 When to Call Your Doctor Call right away if you have: - A shock AND you do not feel well for example, you have passed out or have dizziness, shortness of breath, or chest pain. - More than 1 shock in a row from your device. If you receive a shock AND you are feeling fine, call an EP nurse weekdays 8 a.m. to 4:30 p.m. at If you wish to speak to someone after hours, on the weekend, or on a holiday, call and ask for the EP Fellow on call to be paged. Keep a log of the shocks you receive. It is helpful for your doctor to know: The number of shocks you have had. How you felt before and after each shock. The time of day you received each shock. What you were doing when each shock occurred. Special Long-Term Precautions Travel Always carry your ICD identification card. If you must pass through a metal detector, hand your ICD identification card to security staff and tell them that you might set off the alarm. You may also want to carry a card with this information in the language(s) of the country (or countries) you will visit or travel through. Although some studies show there are no risks to ICDs from metal detectors, most manufacturers still suggest being cautious. - You may walk through the metal-detection arch, but do not remain inside the arch or lean on the sides of the structure. - If a metal-detection hand wand is used, ask security staff to avoid waving or holding it over your ICD. - If you feel dizzy, have fast heartbeats (palpitations), or are shocked by your ICD when you are near a metal detector, simply move farther away. Your ICD should begin to work properly right away. - Body scanners that are used in some airports and other locations will not have any effect on your ICD.

4 Page 4 Always carry a complete list of your current medicines. Include their doses, how often you take them each day, and why you are taking them. Always carry your medicines with you in your carry-on bags. Do not pack them in your checked luggage. Carry phone numbers for your health care providers in case of emergency. Magnetic Fields Magnets or magnetic fields are found in or are created by many items we are around every day. Some of these are: Small appliances with motors Stereo speakers Gas engines Cell phones Desktop and laptop computers Welding machines CB radios Magnetic resonance imaging (MRI) machines Anti-theft devices in stores Metal detectors Most of these items, such as microwaves and blenders, are safe to be close to, but some create magnetic fields that are strong enough to interfere with how your ICD works. Some general recommendations and precautions for sources of magnetic fields are listed below and on pages 5, 6, and 7. For more details, contact the manufacturer of your ICD. NOTE: All recommendations assume that the equipment you are using is properly grounded, is in proper working order, and is being used for its intended purpose. Cell Phones Most cell phones are safe if you: Keep your phone at least 6 inches (15 centimeters) from your surgical site. Hold it to your ear on the opposite side of your ICD to avoid problems.

5 Page 5 Carry your phone in a location that is also at least 6 inches (15 centimeters) away from your implant site. Most cell phones continue to send a signal even when they are not in use. Radio Transmitters Radio transmitters such as CB radios, walkie-talkies, and remotecontrolled toys may interfere with your ICD. Here are guidelines for distances to keep from these items: Watts Generated Distance to Keep From It 3 watts 12 inches (30 centimeters) 25 to 199 watts 3 feet (1 meter) 200 watts or more 10 feet (3 meters) If you are unsure about the power output of your radio transmitter, call the manufacturer. Car Engines and Tools or Appliances with Small Motors Most small appliances or hand tools with motors are safe to use when the item is grounded, in good condition, and is held the recommended distance from your body for safe and proper operation. Use caution when working on car engines. Keep your ICD at least 24 inches (60 centimeters) away from a running car engine. Electric Toothbrushes Keep the toothbrush handle at least 1 inch (2.5 centimeters) away from your ICD. Keep at least 6 inches (15 centimeters) between the charger and your ICD. Medical Procedures or Equipment Be sure the person who is doing your procedure knows you have an ICD. Never assume everyone involved in your health care knows this. It is always safer to be sure and to remind those involved in your care. Take precautions with these procedures or devices: Electrocautery (a surgical procedure that uses an electric current to remove unwanted tissue, seal off blood vessels, or create an incision) Placement of a central venous catheter (a catheter that is placed in a large vein to deliver medicine) Lithotripsy (a procedure that uses shock waves to break up stones in the kidney, bladder, or ureter)

6 Page 6 Ultrasound (an imaging technique) Electrolysis (hair removal) External cardioversion or defibrillation (a procedure to bring an abnormal heart rhythm back to normal) Magnetic resonance imaging (MRI) machines Note: At this time, MRI machines are not safe for patients with ICDs to be in or around. Avoid all MRI exams. Hearing aid with a coil around the neck that detects sounds and sends digital signals to the amplifier Note: Before using this type of hearing aid, call your ICD manufacturer. Radiation therapy (usually used in cancer treatment) TENS (a pain-control device) Body-fat measuring scales Other Precautions Many manufacturers of ICDs recommend that you also avoid being around or using these items: Arc welders Gas-powered chainsaws Induction furnaces such as kilns Magnetic (therapy) mattress pads or pillows Electric steel furnaces Dielectric heaters (heaters that use radiowaves or microwaves to heat) Electrical transmissions towers (if you are inside a restricted area) Jackhammers Stun guns Dental Work Tell your dentist that you have an ICD. Usually, you will not need to be concerned that any of the devices the dentist uses will interfere with your ICD. If you did not need antibiotics for your dental procedures before your surgery, then you will not need antibiotics now that you have an ICD. If you have questions, please ask your doctor.

7 Page 7 Questions? Your questions are important. Call your doctor or health care provider if you have questions or concerns. UWMC clinic staff are also available to help. Cardiology Clinic: Your ICD This handout covers only general precautions you may need to take with your implanted device. Each device may have special precautions to consider. If you have any questions about what might cause problems for your ICD, please contact the manufacturer for more specific information about your newly implanted device. Here is contact information for 4 ICD manufacturers: Biotronik Medtronic Guidant/Boston Scientific St. Jude GUIDANT ( ) University of Washington Medical Center Box Published: 02/1999, 12/2009, 09/ N.E. Pacific St. Seattle, WA Clinician Review: 09/ Reprints on Health Online:

8 Page 8 Your Follow-up Appointments for Your Implantable Cardiac Defibrillator (ICD) The timing of your follow-up appointments will depend on your doctor s treatment plan for you. If you have questions about any of your appointments, please call the Cardiology Clinic at Week 1 or 2 Date: Time: Where: University of Washington Medical Center Regional Heart Center, 3rd floor With: Week 4 (1 month) Date: Time: Where: University of Washington Medical Center Regional Heart Center, 3rd floor With: Week 16 (4 months) Date: Time: Where: University of Washington Medical Center Regional Heart Center, 3rd floor With: Box N.E. Pacific St. Seattl e, WA